Rhinoplasty is a complex surgical procedure that involves the modification of underlying nasal structures such as bone, cartilage, ligaments and soft fibro-fatty tissue. The procedure may be performed for a variety of reasons that include improving the aesthetic appearance of the patient's nose; for reconstructive purposes following trauma; correcting various abnormalities of the nose that the patient may present; and, for correcting nasal passage functional problems associated with breathing for both inhalation and expiration. Regardless of the reasons for the rhinoplasty, the surgeon strives to restore or maintain functionality, remediate structural issues, and at the same time address aesthetic factors by creating and/or maintaining certain proportions between the various part of the nose and face.
One of the most challenging aspects of rhinoplasty is generally considered to be the surgery of the lower third of the nose, mainly the nasal tip region. The stability of the nasal tip is important not only for the aesthetic look and appearance of the nose (e.g., tip projection and tip rotation), but also for physiological and anatomical functions such as appropriate inspiration and expiration, facial expression, and shock absorbance in response to facial trauma.
Preserving or creating adequate support of the nasal tip is important for both the immediate post-operative results and, the long-term outcomes over the life of the patient. Due to factors such as scar contracture, thinning of the soft tissue envelope, and weakening of the cartilage structures with aging, some suboptimal results may be observed soon after surgery, and the consequent deficiencies can often become much more obvious, pronounced, apparent, and prevalent with the passage of time, usually about ten to fifteen years later.
It is known that skin thickness is a factor in determining how well the external skin cover will redrape over the underlying structures of the nose post-surgery. Patients with thin skin tend to have stronger cartilaginous structures, but the underlying structures are more visible, and a step-like transition between the bone and the cartilage can be seen. On the other hand, for patients having thick skin, obtaining proper definition and refinement can be a challenge.
One of the major support mechanisms of the nasal tip is the medial crura of the lower lateral cartilage (LLC). The foundation of the nasal tip is determined by the base (anterior nasal spine) and the footplates of the medial crura. Patients who have long and strong medial crura that extend to the nasal spine are more likely to have adequate tip support. In contrast, patients who have short medial crura, and flaring footplates at the mid-columella are more likely to have poor tip support and lose tip projection after surgery.
Various surgical techniques and procedures that provide long-term support to the tip of the nose and stabilization of the nasal base have been used in the past. One of the widely used techniques is the placement of a columellar strut graft. The graft is usually and typically made of autologous septal or rib cartilage, which is sutured between the medial crus of the lower lateral cartilages. The columellar strut graft can extend to the nasal spine or be placed above the nasal spine. Another surgical method or procedure to provide nasal tip projection and support is the “tongue-in-the-groove” technique, wherein the medial crus of the lower lateral cartilages are sutured to the caudal end of the septum. A septal extension graft may also be used to ensure that the nasal tip projection is maintained postoperatively. Although nonabsorbable implants may be used to support the nasal tip, this method of tip support treatment is not preferred by surgeons because of associated complications such as infection, skin necrosis, and implant extrusion, as well as factors such as patient awareness, appearance.
In order to improve existing surgical procedures and patient outcomes, there is a continuing need in this art for low mass columellar struts with geometric characteristics that enhance the associated implantation procedure and provide for superior patient results. In particular, there is a need in this art for novel implants made from bioabsorbable polymers that are useful in nasal reconstruction surgical procedures.